'Mystery patients' study says doctors can miss health's social determinants

Chicago Tribune: So-called "mystery patients" are showing that doctors often ignore or fail to ask about social determinants when it comes to health outcomes, a recent study suggests, for exampel, testing an emaciated patient for cancer before asking if he got enough to eat (he didn't).

Dr. Saul Weiner began considering "contextual errors" several years ago. "Weiner arranged to send actors playing patients into physicians' offices and discovered that errors occurred in 78 percent of cases when socioeconomic concerns were a significant factor, according to a paper published Monday in the Annals of Internal Medicine." Weiner suggests a systematic way to uncover issues that could lead to poorer health. "Such a 'contextual history' could be taken from patients along with their physical history, he suggests, though the idea may be controversial among time-pressed physicians" (Graham, 7/19).